Two‐Stage Flexor tendon repair versus Primary repair
Published Date: 01st December 2020
Publication Authors: Richards B
Introduction & Aim
In the anatomical extremity, the hand is constantly exposed to the potential risk of injury. If a flexor tendon is injured and recognized as needing surgical intervention, two options are available; Two‐stage Flexor Tendon (TSFT) repair or Primary repair. We evaluated the subjective and functional outcomes of the two surgical methods described above in patients presenting to a regional centre for plastic surgery with flexor tendon injury in Zone I or II over a 5‐year period.
Methodology
A retrospective study employing 35 patients (and a total of 42 tendon injuries) requiring Two‐stage Flexor Tendon repair over a 5‐year period were analysed. Historical data was collected on 190 patients who underwent primary flexor tendon repair between 2012‐2014.
Results
Of the 35 digital injuries assessed, 15.8% had a good outcome, 21.1% with a fair outcome and 63.2% with a poor outcome, based upon the Strickland grading system. In comparison, of those undergoing primary flexor tendon repair, 51.5% had a good / excellent outcome, leaving 48.5% with a poor outcome. Ruptures rates post‐surgery were higher in those undergoing TSFT repair than primary repair; 23.8% versus 12.0% respectively.
Conclusion
IA damaged flexor tendon requiring surgery should be repaired within 72 hours of initial insult via primary repair. Delayed presentation, scar formation and proximal stump retraction warrant a two‐stage approach. It is widely accepted that a reconstruction in two‐stages can yield effective results in restoring digital function, but these results are often superseded by a primary repair.
Mitchell, R; Richards, B; Pearson, T;. (2020). Two‐Stage Flexor tendon repair versus Primary repair: An evaluation of subjective and functional outcomes at a Regional Centre for Plastic Surgery. British Journal of Surgery. 107 (S4), 82-83